Friendly Gadgets, Serious Impact
EUC with HCI: Why It Matters
It's an attractive four-button device with a color screen that looks more like a child's video toy than a medical device. But it has FDA clearance to receive and transmit data from a variety of glucose meters, electronic weight scales, blood pressure meters and a device that measures lung function.
Patients using Health Buddy answer daily questions about their activity and well-being and receive advice about how to improve their health.
Remote monitoring has been around for a long time, according to Health Hero CEO Steve Brown, but new devices can be programmed to interact with the patient.
"Collecting data is just not enough. You really need to coach patients, and then give the right data so clinicians can manage by exception," Brown said.
In other words, clinicians decide precisely which patients to contact and when, based on their vital signs.
Brown thinks remote monitoring and coaching devices will revolutionize how patients interact with the health care system in much the same way that iPod has changed people's experience with the music industry.
"We are changing patients' experience with the health care system; we've changed it from being episodic to something that's chronic."
It can change the way clinicians practice medicine, said Jon Ehrman, associate program director of preventive cardiology at the Henry Ford Heart and Vascular Institute.
He is assessing the Health Buddy device for managing heart failure, comparing it with a traditional disease management program in which nurses call patients periodically to check on how they are doing.
Clinicians like the device, he said, and "have adapted their work day to incorporate the surveillance and response to the information on the HB [Health Buddy]."
Ehrman says preliminary results from his study on heart-failure patients are promising.
Patients show improvements in "functional status, quality of life indicators and a variety of clinical values."
It works for the bottom line as well: Their care costs nearly $140 less per month than for patients without the device.
Patients only take the device if they want to, and spend a few minutes a day interacting with it.
"Most are happy to use a device like this and gain some peace of mind that someone is watching over them," Ehrman said.
In his study, about 90 percent of patients respond to the device daily, more than 70 percent felt that it improved communication with their doctor, and more than four-fifths said they would use the device after the study if offered.
In some cases, an in-home monitoring device could let people with mental health diseases live independently, said Dawn Velligan, co-director of the division of schizophrenia and related disorders at the University of Texas Health Science Center.
She tested an electronic pillbox made by InforMedix that reminds patients when to take pills and records when, and if, patients take their medicines as instructed.
So far, Velligan, who receives consulting fees from InforMedix, has data from 10 patients.
"Adherence prior to study was around 50 percent, and with it it's 94 percent," she said, a statistically significant improvement.
The pillbox also asks patients whether they have completed basic daily tasks like brushing their teeth or getting dressed.
Remote monitoring devices are often part of disease management programs.
Not all of these programs place expensive monitoring devices in the home; instead, some rely on telephone interactions between patients and nurses at call centers to encourage patients to take care of themselves and to help them distinguish danger signals from acceptable fluctuations.
American Healthways, for example, uses remote monitoring devices for some programs, but not for others.
Stegall said she likes the concept of systems that ask patients questions, and that her vendor for monitoring devices, Philips Medical Systems, offers them, but says she wants to see more data before putting them in patients' homes.
For example, she says she wants to be sure that what a patient will tell a device is as reliable as what a patient will tell a nurse.
She expresses a similar attitude toward electronic pillboxes, which currently require clinicians to replenish medicine every month or so: "I don't think all the kinks are worked out yet."
Thukral says the technology still needs to overcome several barriers.
Legal issues can be uncertain.
For example, if the clinician and patient aren't in the same state, it's unclear which states' rules apply.
Privacy and security concerns are in worse shape, he said: "There are not many safeguards that currently exist to take care of the security and privacy of patient data transmitted between two sites.
"No authentication systems exist today to check if the data has been transferred to the right person as planned." (The companies interviewed for this article said that their data are encrypted and that clinicians use authentication procedures.)
Next Page: Hardware cost is a major barrier.
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